Dangerous yet precious

The invaluable treasure housed at Chittagong Medical College (CMC) is closely guarded. Anyone who wants access must navigate their way through a sophisticated security system, don a lab coat, disinfect their hands, pass through an automatic door and then enter via a specially reinforced glass door. Visitors who make it through the last sliding door will be greeted with threatening hisses from the dangerous yet precious treasure that lies within. Three hundred venomous snakes live here in shelves screened with black fabric. Anyone entering the dimly lit, air-conditioned room for the first time could be forgiven for feeling more than a little apprehensive.

Of course the team that works at the CMC Venom Research Centre in Chattogram in south-eastern Bangladesh is in no way put off by this welcome. The research assistants who work with Professor Aniruddha Ghose are on familiar territory. ‘Some snakes get stressed when they sense movement around them. They hiss loudly to signal that people should stay away,’ explains Mizanur Rahman who, like his colleagues, is responsible for looking after and breeding the animals. They use an impressive technique to extract venom, so that they can learn more about the development of the antivenoms that can save human lives. The research scientists clearly feel at home in the company of the reptiles. Today, the team has a visitor, and he feels no different. Dr Ulrich Kuch is one of the world’s most renowned snakebite experts. The biologist heads the Department of Tropical Medicine and Global Health at the Goethe University’s Institute of Occupational, Social and Environmental Medicine in Frankfurt am Main. He is actively involved in a hospital partnership between the hospital on the Bay of Bengal and the Frankfurt University Hospital. Since 2020, both institutions have been part of a global hospital partnership funding programme implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ).

Kuch had already established links to CMCH and other hospitals in Bangladesh. For many years, German and Bangladeshi research scientists have been working together in the field of poisoning and snakebites. This is an urgent problem, especially in rural areas. Experts estimate that some 700,000 people are bitten by snakes every year in Bangladesh. The World Health Organization (WHO) reports that an average of 16 people die here every day from snakebites. Most victims are young. Kuch knows all too well from the time he has spent in Asia the anguish this can cause, as well as tipping families into poverty if the breadwinner dies or becomes permanently unfit for work as a result of amputations or other disabilities. For a long time, the devastating health and economic problems that snakebites pose for people living in rural parts of the Global South were not fully recognised. Today, the World Health Organization has classed snakebite envenoming as a highest priority neglected tropical disease.

After a morning spent at the Venom Research Centre, Kuch and Ghose walk across to the adjacent hospital. Every day, the hospital admits victims of snakebites or poisoning – around 5,000 admissions a year in total. Chittagong Medical College Hospital serves a vast catchment area. The densely populated region is home to forty million people, almost a quarter of the country’s entire population. But snakebites are not the only cause of poisoning. The hospital also treats people who have tried to take their own lives using pesticides, often in despair at their poverty and family debts. Despite recording moderate economic growth, Bangladesh remains one of Asia’s poorest countries

CMCH treats everyone who seeks help. It now benefits from equipment procured under the hospital partnership, including mobile ultrasound equipment that can be used right at the patient’s bedside. During a visit to the unit, Professor Ghose highlights the pivotal importance of this equipment and stresses how valuable it has been to receive support from Germany throughout the coronavirus pandemic. For patients with acute poisoning, in particular, transporting them anywhere for examination purposes is far too demanding. In these cases, the mobile ultrasound equipment works ‘like a magic wand’, say the doctors. Without having to move patients, the equipment delivers precise data about their internal organs and helps identify effective treatment. ‘The hospital partnership programme made this urgently needed modernisation possible and enabled us to train our health specialists to use the equipment,’ Aniruddha Ghose tells Kuch as they walk through the bustling unit to check on a patient who has just been examined in bed using the ultrasound equipment.

CMCH has created space for a laboratory and a training centre to ensure that all doctors can work with the new equipment and use it in training. ‘This skill lab not only improves patient care. Medical specialists are also being trained in the use of modern methods,’ Ghose explains. ‘In future, this will help disseminate expertise throughout the country,’ Kuch adds. Both men are wholly dedicated to the partnership, under which each side learns from the other on an interdisciplinary basis. Experts share their knowledge and ideas. ‘CMC has established the first Venom Research Centre of its kind on the South Asian subcontinent, thanks in part to the financial support provided by Bangladesh’s Government, the assistance of brilliant zoology graduates from the University of Chittagong, and successful cooperation with its German partners,’ stresses Ulrich Kuch. Discussions with colleagues from Bangladesh regularly give him food for thought – he learns more about the local snake population, for instance.

The Bangladesh-German tandem already have their eyes set on the next goal. To manufacture affordable antivenom tailored specifically to the local requirements, the country needs a larger facility than the modest centre at CMC. This is the only way to ensure that enough high-quality snake venom can be harvested in a controlled research laboratory using modern scientific methods. At the moment, the only antivenom available in Bangladesh is produced in India. The imported products are not very effective. ‘Our joint research has shown that venom from snakes like Russell’s vipers and cobras in Bangladesh contain quite different toxins to those in India,’ says Kuch. However, the Indian antidote is unable to neutralise these toxins.

Meanwhile, back at the Venom Research Centre, an impressive Russell’s viper is being milked. The experts at Chittagong Medical College Hospital continue to work with their invaluable animals – which are both dangerous and precious.